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Background Outcomes with postprostatectomy salvage radiation therapy (SRT) are not ideal. Little evidence exists regarding potential benefits of adding whole pelvic radiation therapy (WPRT) alone or in combination with androgen deprivation therapy (ADT). Objective To explore whether WPRT and/or ADT added to prostate bed radiation therapy (PBRT) improves freedom from biochemical failure (FFBF) or distant metastases (DM). Design, setting, and participants A database was compiled from 10 academic institutions of patients with postprostatectomy prostate-specific antigen (PSA) >0.01 ng/ml; pT1-4, Nx/0, cM0; and Gleason score (GS) ≥7 treated between 1987 and 2013. Median follow-up was 51 mo. Interventions WPRT and/or ADT in addition to PBRT. Outcome measurements and statistical analyses FFBF and DM were calculated using cumulative incidence estimation. Multivariable analysis (MVA) utilized cumulative incidence regression. Results and limitation Median pre-SRT PSA was 0.5 ng/ml for 1861 patients. Median follow-up for patients not experiencing biochemical failure (BF) was 55 mo. MVA showed increased BF for PBRT versus WPRT (hazard ratio [HR] 1.82, p < 0.001) and no ADT versus ADT (HR 1.70, p < 0.001). WPRT was associated with a 5-yr FFBF of 62% versus 49% ( p < 0.001) for PBRT. ADT use was associated with improved 5-yr FFBF (55% vs 50%, p = 0.012). No significant differences in DM cumulative incidence were found. Conclusions For patients with GS ≥7 receiving SRT, clinicians should weigh FFBF benefits of WPRT and ADT against toxicities. Future studies should explore the impact of WPRT on quality of life, clinical progression, and overall survival. Patient summary We evaluated patients with prostate cancer treated with radiation after surgery to remove the prostate. Both radiation to the pelvic lymph nodes and suppression of testosterone lowered the chance of increasing prostate-specific antigen (a marker for cancer returning). [ABSTRACT FROM AUTHOR]

Purpose: To review the literature on use of radiation as a salvage option after local-only failure following initial treatment with radiation. Methods: PubMed was searched from inception to June 2012 using terms designed to include relevant articles on salvage radiation as a treatment for local-only failures after radiation. Results: Eighteen separate studies were found which demonstrated widely different patient populations, treatment methods, follow-up periods, and reporting. Only one phase II prospective study was found with no randomized controlled trials. Biochemical disease-free survival (bDFS) at four to 5 years ranged from 20 to 75 %. Patient selection may have influenced these varying rates since some studies with lower bDFS had higher risk populations. Factors associated with improved bDFS included post-treatment prostate-specific antigen (PSA) nadir of <0.5 ng/mL, pre-salvage PSA <6, Gleason score ≤7, and PSA doubling time (PSADT) >10 months. Overall survival ranged from 54 to 94 %, and disease-specific survival ranged from 74 to 100 %. The crude rate of grade 3–4 genitourinary toxicities among all studies was 13 % (range 0–47 %), and the crude rate of grade 3–4 gastrointestinal toxicities was 5 % (range 0–20 %). Incontinence rates were low among reviewed studies at 4 % (range 0–29 %). Conclusions: Brachytherapy represents a reasonable salvage option for patients with local recurrence after initial radiotherapy for prostate cancer. However, rates of toxicities, as in other salvage treatments, can be fairly high, and the likelihood of death from prostate recurrence variable. Prospective studies are needed to better define the efficacy and toxicity of this treatment modality. [ABSTRACT FROM AUTHOR]